加味大柴胡汤早期改善胃空肠吻合术后胃肠动力的测压研究

A Manometry Study of Dachaihu Decoction for Early Improvement of Postoperative Gastrointestinal Motility after Gastrojejunostomy

目的探讨胃空肠吻合术后消化间期移行性复合波(MMC)Ⅲ相的特点及加味大柴胡汤早期改善术后胃肠动力的作用。方法选取北京中医药大学东方医院普外科、中国医学科学院肿瘤医院腹部外科2008年9月至2009年4月符合纳入标准的18例患者完全随机化分为给药组与对照组,每组各9例。术中放置测压管,并于术后6、24、48、72 h在基础治疗的同时给药组经空肠营养管给予加味大柴胡汤100 mL,对照组经空肠营养管给予0.9%氯化钠100 mL,分别记录、分析、比较各组残胃、吻合口及空肠的测压结果,观察MMCⅢ相的变化规律特点。同时对比观察各组肠鸣音恢复时间、排气时间及胃肠减压量情况。结果术后6 h测压各组均未出现明显压力改变,未检获MMC相变化。但在术后第24、48、72 h胃肠测压检获压力波形,其中给药组在给予中药后MMCⅢ相无论出现时间、顺行传导规律均早于对照组,并且各测压点相波幅度、相波频率、持续时间、动力指数亦显著高于对照组(P<0.05)。另外,给药组肠鸣音恢复时间[(2.6±0.9)d vs(3.6±1.5)d],排气时间[(3.1±1.0)d vs(4.1±1.5)d]显著早于对照组,差异有统计学意义(P<0.05),但各组均缺乏MMCⅡ相。结论胃空肠吻合术后给予加味大柴胡汤能加速MMC各相运动恢复,促进MMCⅢ相收缩波出现,增加顺行传导,从而改善术后胃肠运动功能。

Objective To discuss the feature of postoperative migrating motor complex（MMp） phase IH and the effect of modified dachaihu decoction to improve gastrointestinal motility early after gastmjcjunostomy. Methods A total of 18 patients performed gastrojejunostomy in Department of General Surgery, Dongfang Hospital, Beijing University of Chinese Medicine and Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medi- cal Sciences were randomly divided into dose group and control group, 9 patients in each group. The manometry catheter was placed in digestive tract intraoperatively. After 6/24/48/72 hours, on the basis of basic treatment, the dose group was given modified dachaihu decoction 100 mL through jejunum, and the control group was given 0.9% sodium chloride 100 mL through jejunum, the pressure at the gastric remnant point, anastomotie stoma point and jejunum point were recorded, and the postoperative MMC Ⅲ changing regularity were observed, and the bowl sound recovery time, exhaust time and decompression amount of the groups were observed and compared. Results After 6 hours no any obvious pressure change or MMC were observed in each group. However, pressure and MMC Ⅲ after 6/24/48/72 hours in the dose group appeared earlier than the control group, all the data including AMPL, FREQ, TIME, MI of the dose group were higher than the control group （ P 〈 0.05 ）. And the bowel sound recovery time of dose group was（2.6± 0.9 ） d, exhaust time was （ 3.1± 1.0 ） d, shorter than those of the control group＇ s （ 3.6 ± 1.5 ） d and （4.1 ± 1. 5 ） d, with statistically significant difference （ P 〈 0.05 ）. Conclusion Ater gastrojejunostomy, modified dachaihu decoction can be used to accelerate different phases MMC motility recovery, promote the occurrence of MMC Ⅲ contraction wave, increase the anterogradc conduction, thus to improve postoperative gastrointestinal motility.